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SANJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STOSKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Amount ID AR0038395 <br /> Facility ID r FA0021244 <br /> Date Printed F 3/4/2015 <br /> MILES, ADAM H RE : J & R ENVIRONMENTAL <br /> J & R ENVIRONMENTAL 7557 W CARMELO AVE <br /> 43422 CALLE DE VELARDO TRACY, CA 95304 <br /> TEMECULA, CA 92592 <br /> OWNER : J & R ENVIRONMENTAL <br /> Date Health <br /> Program Description <br /> Amount <br /> Invoice# IN0263272---Date of invoice: 1129/2015 1111111111 IN 1111111111111111111 <br /> 1/29/2015 1921 HMBP-Regular-Primary Location $ 510.00 <br /> 1/29/2015 2220 SM HV1 GEN<5 TONS/VR $ 213.00 <br /> 1/29/2015 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 35.00 <br /> Total forth is Invoice $ 758.00 <br /> Payment Due Date 2/28/2015 <br /> TOTAL DUE this Billing Period $ 758.00 <br /> Cr <br /> V <br /> \V\ <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your YMENT <br /> Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254 rpt <br />